• Journal of Chest Surgery
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• v.34 no.8
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• pp.604-610
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• 2001

Stanford type A aortic dissection after graft replacement of ascending aorta and/or aortic arch required careful follow-up due to progression of the enlarged false lumen or the recurrence of dissection. From June 1984 to June 200, 124 patients underwent operations for type A aortic dissection. Among them, 6 patients underwent reoperation due to recurred aneurysm or dissection. We evaluated that the causes of reoperation, including Marfan syndrome, the approach and result of reoperation, and strategy to reduce the risk of reoperation. Material and method: The first operation was done on acute stage in 4 cases, and chronic stage in 2 cases. There were Marfan syndromes in 3 cases. The entry site was the ascending aorta for all cases except one who underwent Bentall operation(n=3) or ascending aorta graft replacement(n=2). In one case, Bentall operation and total arch replacement was performed due to chronic type A dissection with multiple fenestrations. Mean interval of reoperation was 67.6months(range 5 months to 14 year 4months) after the first operation. Reoperations were performed with recurrence of dissection(n=4), threatening aneurysmal evolution of persisting dissection(n=1), and false aneurysm with infection(n=1). The redo operation involved the hemiarch in 1 case, distal ascending to total arch and descending thoracic aorta in 4 cases, and only descending thoracic aorta in 1 case. Result: There were Marfan syndromes in 18 patients. The mean age in type A dissection was 56.7 years and that in the first operation of reoperationc ases was 32.2 years. Especially in 3 patients with Marfan syndrome, the mean age was 29 years.

• The Journal of Korean Medicine
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• v.28 no.1 s.69
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• pp.224-236
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• 2007

Background : Chunghyul-dan is a combinatorial herbal medicine; previous studies reported it had therapeutic effects for microangiopathy, a major part in the progression of small vessel disease, as well as having anti-hypertensive, anti-hyperlipidemic, anti-apoptotic, anti-oxidative, and anti-inflammatory activities. Therefor, we examined the inhibitory effect of Chunghyul-dan on stroke recurrence in patients with small vessel disease. Methods : We prescribed Chunghyul-dan at 600 mg a day to patients with small vessel disease, and monitored stroke recurrence, drug compliances, and adverse effect for 1 year. We then performed follow-up brain MRI to find new vascular lesions after 1 year of Chunghyul-dan medication. For the subjects lost to follow-up, we assessed their prognosis after 1 year by telephone. Results : There were 73 subjects treated with Chunghyul-dan for 1 year; new vascular events were found in 3. Of the 85 subjects lost to follow-up, fifty four could be contacted, and eight of them had stroke recurrence. One year of Chunghyul-dan medication reduced the odds ratio of stroke recurrence by 75% compared to the subjects lost to follow-up and the rate increased to 88%, when adjusted for other relevant risk factors for stroke recurrence. These reductions were much higher than those of aspirin and other kinds of conventional anti-platelets. There was no adverse effect in any of the study subjects. Conclusions : We suggest Chunghyul-dan could be useful for inhibition of stroke recurrence. Further study with a randomized controlled trial is needed to confirm this suggestion.

• Journal of the Korean Dietetic Association
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• v.12 no.3
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• pp.254-263
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• 2006

Background: Type 2 diabetes is occuring in epidemic proportions worldwide and aging has been defined as one of the risk factors for the progression to diabetes. High carbohydrates intake increases blood sugar level and obesity in type 2 diabetes. The purpose of this study was to examine the relationship between carbohydrate intake and obesity in type 2 diabetes. Methods: The study subjects were 72 patients (male 27, female 45), who had been diagnosed as type 2 diabetes at Seoul National University of Bundang Hospital. Their anthropometric(height, weight, waist and hip circumference), biochemical(fasting blood sugar, postprandial -2hour blood sugar, HbA1C, C-peptide, insulin, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol) and body composition were measured. Dietary data were collected by trained interviewers using three non-consecutive food records. Results: The mean age of the subjects was 55.86$\pm$9.30 years, and the mean duration of disease was 1.9$\pm$1.72 years. The mean fasting blood sugar, postprandial-2hour blood sugar and HbA1C of the subjects were 151.91$\pm$34.65mg/dl, 235.23$\pm$70.74mg/dl and 7.45$\pm$1.13%, respectively. There was significant positive correlation of the percent body fat and hip to carbohydrate intake/kg of body weight in obese males (p<0.05). However, the correlation of biochemical factors to carbohydrate intake was not significantly different in obese and non-obese male. The correlation of anthropometry to carbohydrate intake/kg of body weight was not significantly different in obese and non-obese females (p<0.05), and other nutrients. We found significant association between carbohydrate intake and obesity in obese males among type 2 diabetes. The females in type 2 diabetes were affected by several factors rather than energy nutrient intake. Conclusion: In conclusion, the correlation of carbohydrate intake with obesity factor was different in males and females. Therefore, diabetic educators should individualize diabetes nutrition therapy considering the gender.

• Toxicological Research
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• v.27 no.4
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• pp.253-259
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• 2011

Transforming growth factor ${\beta}$ (TGF-${\beta}$) is involved in cellular processes including growth, differentiation, apoptosis, migration, and homeostasis. Generally, TGF-${\beta}$ is the inhibitor of cell cycle progression and plays a role in enhancing the antagonistic effects of many growth factors. Unlike the antiproliferative effect of TGF-${\beta}$, E2, an endogeneous estrogen, is stimulating cell proliferation in the estrogen-dependent organs, which are mediated via the estrogen receptors, $ER{\alpha}$ and $ER{\beta}$, and may be considered as a critical risk factor in tumorigenesis of hormone-responsive cancers. Previous researches reported the cross-talk between estrogen/$ER{\alpha}$ and TGF-${\beta}$ pathway. Especially, based on the E2-mediated inhibition of TGF-${\beta}$ signaling, we examined the inhibition effect of 4-tert-octylphenol (OP) and 4-nonylphenol (NP), which are well known xenoestrogens in endocrine disrupting chemicals (EDCs), on TGF-${\beta}$ signaling via semi-quantitative reverse-transcription PCR. The treatment of E2, OP, or NP resulted in the downregulation of TGF-${\beta}$ receptor2 (TGF-${\beta}$ R2) in TGF-${\beta}$ signaling pathway. However, the expression level of TGF-${\beta}1$ and TGF-${\beta}$ receptor1 (TGF-${\beta}$ R1) genes was not altered. On the other hand, E2, OP, or NP upregulated the expression of a cell-cycle regulating gene, c-myc, which is a oncogene and a downstream target gene of TGF-${\beta}$ signaling pathway. As a result of downregulation of TGF-${\beta}$ R2 and the upregulation of c-myc, E2, OP, or NP increased cell proliferation of BG-1 ovarian cancer cells. Taken together, these results suggest that E2 and these two EDCs may mediate cancer cell proliferation by inhibiting TGF-${\beta}$ signaling via the downregulation of TGF-${\beta}$ R2 and the upregulation of c-myc oncogene. In addition, it can be inferred that these EDCs have the possibility of tumorigenesis in estrogen-responsive organs by certainly representing estrogenic effect in inhibiting TGF-${\beta}$ signaling.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.6
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• pp.2935-2940
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• 2016

Breast cancer is the most frequent type of cancer diagnosed among women worldwide and also in Thailand. Estrogen and estrogen receptors exert important roles in its genesis and progression. Several cytokines have been reported to be involved in the microenvironment that promotes distant metastasis via modulation of immune and inflammatory responses to tumor cells. Estrogen receptor genetic polymorphisms and several cytokines have been reported to be associated with breast cancer susceptibility and aggressiveness. To investigate roles of genetic polymorphisms in estrogen receptor alpha (ESR1) and interleukin 6 (IL6), breast cancer patients and control subjects were recruited from the Division of Head, Neck and Breast Surgery (Siriraj Hospital, Bangkok, Thailand). Polymorphisms in ESR1 (rs3798577) and IL6 (rs1800795 and rs1800797) were evaluated by real-time PCR in 391 breast cancer patients and 79 healthy controls. Associations between genetic polymorphisms and clinicopathological data were determined. There was no association between genetic polymorphisms and breast cancer susceptibility. However the ESR1 rs3798577 CT genotype was associated with presence of lymphovascular invasion (OR=2.07, 95%CI 1.20-3.56, p=0.009) when compared to the TT genotype. IL6 rs1800795 CC genotype was associated with presence of extranodal extension (OR= 2.30, 95%CI 1.23-4.31, p=0.009) when compared to the GG genotype. Survival analysis showed that IL6 rs1800797 AG or AA genotypes were associated with lower disease-free survival. These findings indicate that polymorphisms in ESR1 and IL6 contribute to aggressiveness of breast cancer and may be used to identify high risk patients.

• Tuberculosis and Respiratory Diseases
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• v.84 no.2
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• pp.125-133
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• 2021

Background: The coronavirus disease (COVID-19) can manifest in a range of symptoms, including both asymptomatic systems which appear nearly non-existent to the patient, all the way to the development of acute respiratory distress syndrome (ARDS). Specifically, COVID-19-associated pneumonia develops into ARDS due to the rapid progression of hypoxia, and although arterial blood gas analysis can assist in halting this deterioration, the current environment provided by the COVID-19 pandemic, which has led to an overall lack of medical resources or equipment, has made it difficult to administer such tests in a widespread manner. As a result, this study was conducted in order to determine whether the levels of oxygen saturation (SpO₂) and the fraction of inhaled oxygen (FiO₂) (SF ratio) can also serve as predictors of ARDS and the patient's risk of mortality. Methods: This was a retrospective cohort study conducted from February 2020 to Mary 2020, with the study's subjects consisting of COVID-19 pneumonia patients who had reached a state of deterioration that required the use of oxygen therapy. Of the 100 COVID-19 pneumonia cases, we compared 59 pneumonia patients who required oxygen therapy, divided into ARDS and non-ARDS pneumonia patients who required oxygen, and then investigated the different factors which affected their mortality. Results: At the time of admission, the ratios of SpO₂, FiO₂, and SF for the ARDS group differed significantly from those of the non-ARDS pneumonia support group who required oxygen (p<0.001). With respect to the predicting of the occurrence of ARDS, the SF ratio on admission and the SF ratio at exacerbation had an area under the curve which measured to be around 85.7% and 88.8% (p<0.001). Multivariate Cox regression analysis identified that the SF ratio at exacerbation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.846-0.991; p=0.029) and National Early Warning Score (NEWS) (HR, 1.277; 95% CI, 1.010-1.615; p=0.041) were significant predictors of mortality. Conclusion: The SF ratio on admission and the SF ratio at exacerbation were strong predictors of the occurrence of ARDS, and the SF ratio at exacerbation and NEWS held a significant effect on mortality.

• Journal of Digestive Cancer Research
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• v.2 no.2
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• pp.64-67
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• 2014

Esophageal cancer has a poor prognosis, because the progression rate is faster compared to that of other cancers, Up to 30-40% of cases are inoperable at diagnosis, and most cases occur in the elderly. By this time, surgery has been regarded as the treatment of choice in patients suffering esophageal cancer and recent improvements in surgical techniques and perioperative management have significantly increased the resection rate and reduced the operative mortality. And Although the combination of chemotherapy and radiation therapy has been reported to be an effective treatment for esophageal cancer, most cases show only partial remission. Moreover, radiation therapy alone or chemotherapy alone has limited efficacy. We report a rare case of an 80-year-old man who presented with a chief complaint of dysphasia and was diagnosed with advanced esophageal cancer, with a review of the literature. Considering his advanced age, generally poor performance status, and the risk of fistula development after radiation therapy due to indentation of esophageal cancer into the main bronchus, palliative, rather than therapeutic, chemotherapy was performed, and complete remission was obtained.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.94-101
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• 2024

Purpose: Coronavirus disease 2019 (COVID-19) has posed a significant burden to infant and toddler's care globally, while the disease severity is generally mild in this age group. In this study, we aimed to assess epidemiological and clinical aspects of COVID-19 in infants and toddlers in Seoul, South Korea. Methods: We used Seoul Metropolitan Government's epidemiological investigation database to describe the epidemiological and clinical characteristics of COVID-19 in infants and toddlers, between March 2020 to December 2021. Results: A total of 5,025 infants and toddlers aged <5 years was diagnosed between the observed period. 2,720 (54.1%) had symptoms, and fever was the most common symptom in 1,941 (74.1%). Of the diagnosed cases, 96.4% did not have underlying diseases. In a district level, extended opening of childcare facility was associated with increased risk of COVID-19 in infants and toddlers. Conclusions: An efficient monitoring system, resembling routine clinical care, is crucial, considering the low rates of severe progression and fatality among infants and toddlers. Moreover, a well-grounded intervention based on scientific evidence, rather than unconditional closures, is necessary to establish a suitable childcare policy that ensures safety from infectious diseases while not overlooking the developmental aspects of social skills.

• Journal of Life Science
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• v.34 no.6
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• pp.418-425
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• 2024

Solid tumors are heterogeneous populations of multiple cell types. While the majority of the cells that comprise cancer are unable to divide, cancer stem cells have self-renewal and differentiation properties. Normal stem cell pathways that control self-renewal are overactivated in cancer stem cells, making cancer stem cells important for cancer cell expansion and progression. Dick first proposed the definition of cancer stem cells in acute myeloid leukemia, according to which cancer stem cells can be classified based on the expression of cell surface markers. Cancer stem cells maintain their potential in the tumor microenvironment. Multiple cell types in the tumor microenvironment maintain quiescent cancer stem cells and serve as regulators of cancer growth. Since current cancer treatments target proliferative cells, quiescent state cancer stem cells that are resistant to treatment increase the risk of recurrence or metastasis. Various signals of the tumor microenvironment induce changes to become a tumor-supportive environment by remodeling the vasculature and extracellular matrix. To effectively treat cancer, cancer stem cells and the tumor microenvironment must be targeted. Therefore, it is important to understand how the tumor microenvironment induces reprogramming of the immune response to promote cancer growth, immune resistance, and metastasis. In this review, we discuss the cellular and molecular mechanisms that can enhance immunosuppression in the tumor microenvironment.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.62-69
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• 2024

Background: Cervical esophageal cancer is a rare malignancy that requires specialized care. While definitive chemoradiation is the standard treatment approach, surgery remains a valuable option for certain patients. This study examined the surgical outcomes of patients with cervical esophageal cancer. Methods: The study involved a retrospective review and analysis of 24 patients with cervical esophageal cancer. These patients underwent surgical resection between September 1994 and December 2018. Results: The mean age of the patients was 61.0±10.2 years, and 22 (91.7%) of them were male. Furthermore, 21 patients (87.5%) had T3 or T4 tumors, and 11 (45.8%) exhibited lymph node metastasis. Gastric pull-up with esophagectomy was performed for 19 patients (79.2%), while 5 (20.8%) underwent free jejunal graft with cervical esophagectomy. The 30-day operative mortality rate was 8.3%. During the follow-up period, complications included leakage at the anastomotic site in 9 cases (37.5%) and graft necrosis of the gastric conduit in 1 case. Progression to oral feeding was achieved in 20 patients (83.3%). Fifteen patients (62.5%) displayed tumor recurrence. The median time from surgery to recurrence was 10.5 months, and the 1-year recurrence rate was 73.3%. The 1-year and 3-year survival rates were 75% and 33.3%, respectively, with a median survival period of 17 months. Conclusion: Patients with cervical esophageal cancer who underwent surgical resection faced unfavorable outcomes and relatively poor survival. The selection of cases and decision to proceed with surgery should be made cautiously, considering the risk of severe complications.